Provider Demographics
NPI:1356387872
Name:SIMPSON, KELLY H (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:H
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:A
Other - Last Name:HETHERINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6210 E HWY 290
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1142
Mailing Address - Country:US
Mailing Address - Phone:512-483-9596
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:1401 MEDICAL PARKWAY
Practice Address - Street 2:BLDG. B #220
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7464
Practice Address - Country:US
Practice Address - Phone:512-260-1581
Practice Address - Fax:512-528-7940
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL25051208000000X
TXN2565207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204494302Medicaid
TX203699801Medicaid
TX203699802Medicaid
TX203699802Medicaid
TX203699801Medicaid